Abstract
Purpose: We aimed to investigate the significance of Achilles tendon (AT) thickness (T) and AT strain ratio (SR), determined by AT ultrasonography (US) and strain elastography (SE), in determining patients with mitral annulus calcification (MAC).
 Materials and Methods: 100 patients (65 females, 35 males, mean age 64.7 ± 12.1 years) diagnosed with MAC after echocardiography and 50 control subjects (32 females, 18 males, mean age 63.2 ± 12.8 years) with similar cardiovascular risk factors were included. Laboratory tests and AT US were performed. AT T and AT-SR were calculated.
 Results: AT -T and AT-SR were found to be significantly higher in patients with MAC. In multivariate logistic regression analysis, AT -T and AT-SR independently determined the risk for MAC. According to this analysis, AT -T (1 mm each) and AT-SR (0.1 each) increased the risk for MAC by 69.9% and 12.7%, respectively. When ROC was analyzed using AT -T and AT-SR to predict patients with MAC, the areas under the curve (AUC) of ROC were 0.684 and 0.819, respectively. In the same analysis accepting the cut-off value of 1.25 for AT-SR, the presence of MAC was detected with a sensitivity of 94.1% and a specificity of 76.2%.
 Conclusion: AT-SR detected in AT SE examination is a simple, reproducible, inexpensive, and noninvasive parameter that can be used to predict patients with MAC. This may be due to the fact that the increase in MAC and AT-SR may be associated with similar physiopathological mechanisms.
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